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Effect of PEEP on Regional Ventilation and Perfusion in the Mechanically Ventilated Preterm Lamb

Department of Pediatrics, North Shore University Hospital, Cornell University Medical College, Manhasset, New York
Clinical Research Center, Brookhaven National Laboratory, Upton, New York
Department of Medicine, North Shore University Hospital, Cornell University Medical College, Manhasset, New York

Correspondence: For reprints contact: Jerrold S. Schlessel, MD, Dept. of Pediatrics, North Shore University Hospital, Cornell University Medical College, 300 Community Dr., Manhasset, NY 11030.

ABSTRACT

Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion () with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107–126 days/145 days gestation). Changes in and were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive ^81mKr, and infused ^81mKr/dextrose and/or [^99mTc]MAA as PEEP was applied at 2, 4, and 6 cm H₂O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H₂O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of shifted from the rostral to the caudal lung regions (p < 0.02 to < 0.05), while that of remained unchanged. Regional / matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H₂O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional and matching in preterm lambs and may be clinically applicable to ventilated neonates.

FOOTNOTES

^* Present address: Akademisch Ziekenhuis, Vrije Universiteit, Laarbecklaan 101, 1090 Brussels, Belgium.